Efficient strategy for controlling postoperative hemorrhage in total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Transfusion Medicine

Background:

• Allogeneic blood transfusions (ABTs) carry risks and costs.
• Minimizing ABTs in total knee arthroplasty (TKA) is a clinical priority.
• Preoperative autologous blood donation (PABD) is one strategy to reduce ABTs.

Purpose of the Study:

• To compare the efficacy of intraoperative tranexamic acid (TNA) plus intra-articular diluted epinephrine (DEP) versus PABD in reducing ABTs during primary unilateral TKA.
• To evaluate postoperative blood loss and complication rates associated with each method.

Main Methods:

• Retrospective analysis of 133 primary unilateral TKA patients.
• Group A: Received PABD (n=51).
• Group B: Received TNA and intra-articular DEP (n=42).
• Group C: Received TNA, DEP, and drain-clamp method (n=40).
• Compared rates of ABT avoidance, blood loss, and complications (DVT/PE, skin issues).

Main Results:

• No significant difference in ABT avoidance rates among groups (94% A, 93% B, 95% C).
• Total blood loss was significantly lower in TNA+DEP groups (852±343 ml B, 850±296 ml C) compared to PABD (1140±451 ml A).
• No significant complications were observed in any group.

Conclusions:

• Intraoperative TNA plus DEP is as effective as PABD in avoiding ABTs in unilateral primary TKA.
• The TNA plus DEP method is recommended due to the drawbacks of PABD.
• This approach may decrease the need for PABD, especially for patients with preoperative Hb ≥10.5 g/dL.